Bottom Line:
Deficits of airway protection can have deleterious effects to health and quality of life.Swallowing prevents material from entering the airway and coughing ejects endogenous material from the airway.It will serve to provide a basis from which to develop future studies and test specific hypotheses that advance our field and ultimately improve outcomes for people with airway protective deficits.

ABSTRACTDeficits of airway protection can have deleterious effects to health and quality of life. Effective airway protection requires a continuum of behaviors including swallowing and cough. Swallowing prevents material from entering the airway and coughing ejects endogenous material from the airway. There is significant overlap between the control mechanisms for swallowing and cough. In this review we will present the existing literature to support a novel framework for understanding shared substrates of airway protection. This framework was originally adapted from Eccles' model of cough (2009) by Hegland, et al. (2012). It will serve to provide a basis from which to develop future studies and test specific hypotheses that advance our field and ultimately improve outcomes for people with airway protective deficits.

f02: Proposed framework of airway protection. Cough and swallowing share afferents (a)that are essential to the initiation and modification of the behaviors. Thisafferent (a) information is then sent to the sensory nuclei (b) located in thebrainstem. There, the behavioral control assembly (BCA) (c) will receive theafferent information and exert control over the swallowing and cough centralpattern generators (CPGs) (d & e) in order to generate the appropriate airwayprotective behavior. Information fed into the motor nuclei (f) is then sent to theefferent (g) nerves. Information from the brainstem sensory nuclei (b) travelsthrough ascending pathways to the cortex via the thalamus, allowing forsomatosensation (h) of the stimulus. Preceding the motor output there is an urgeto act (i) on the stimulus. This will enable suppression or up-regulation of theairway protective behavior through volitional control (j). Both cough andswallowing can be initiated through volitional control (k), or on command. Thisneural information then travels through descending pathways to the brainstem andthen through efferents (g) to the periphery

Mentions:
Cough and swallowing are sensorimotor behaviors which share neuroanatomical substrates.The proposed framework presented in Figure 2illustrates these shared mechanisms. We now present a general overview of the frameworkfor airway protection. To begin, cough and swallowing share afferents (a) that areessential to the initiation and modification of the behaviors. This afferent (a)information is then sent to the sensory nuclei (b) located in the brainstem. There, thebehavioral control assembly (BCA) (c) will receive the afferent information and exertcontrol over the swallowing and cough central pattern generators (CPGs) (d & e) inorder to generate the appropriate airway protective behavior. Information fed into themotor nuclei (f) is then sent to the efferent (g) nerves, ultimately resulting in theexecution of the behavior.

f02: Proposed framework of airway protection. Cough and swallowing share afferents (a)that are essential to the initiation and modification of the behaviors. Thisafferent (a) information is then sent to the sensory nuclei (b) located in thebrainstem. There, the behavioral control assembly (BCA) (c) will receive theafferent information and exert control over the swallowing and cough centralpattern generators (CPGs) (d & e) in order to generate the appropriate airwayprotective behavior. Information fed into the motor nuclei (f) is then sent to theefferent (g) nerves. Information from the brainstem sensory nuclei (b) travelsthrough ascending pathways to the cortex via the thalamus, allowing forsomatosensation (h) of the stimulus. Preceding the motor output there is an urgeto act (i) on the stimulus. This will enable suppression or up-regulation of theairway protective behavior through volitional control (j). Both cough andswallowing can be initiated through volitional control (k), or on command. Thisneural information then travels through descending pathways to the brainstem andthen through efferents (g) to the periphery

Mentions:
Cough and swallowing are sensorimotor behaviors which share neuroanatomical substrates.The proposed framework presented in Figure 2illustrates these shared mechanisms. We now present a general overview of the frameworkfor airway protection. To begin, cough and swallowing share afferents (a) that areessential to the initiation and modification of the behaviors. This afferent (a)information is then sent to the sensory nuclei (b) located in the brainstem. There, thebehavioral control assembly (BCA) (c) will receive the afferent information and exertcontrol over the swallowing and cough central pattern generators (CPGs) (d & e) inorder to generate the appropriate airway protective behavior. Information fed into themotor nuclei (f) is then sent to the efferent (g) nerves, ultimately resulting in theexecution of the behavior.

Bottom Line:
Deficits of airway protection can have deleterious effects to health and quality of life.Swallowing prevents material from entering the airway and coughing ejects endogenous material from the airway.It will serve to provide a basis from which to develop future studies and test specific hypotheses that advance our field and ultimately improve outcomes for people with airway protective deficits.

ABSTRACTDeficits of airway protection can have deleterious effects to health and quality of life. Effective airway protection requires a continuum of behaviors including swallowing and cough. Swallowing prevents material from entering the airway and coughing ejects endogenous material from the airway. There is significant overlap between the control mechanisms for swallowing and cough. In this review we will present the existing literature to support a novel framework for understanding shared substrates of airway protection. This framework was originally adapted from Eccles' model of cough (2009) by Hegland, et al. (2012). It will serve to provide a basis from which to develop future studies and test specific hypotheses that advance our field and ultimately improve outcomes for people with airway protective deficits.